By: Stefanie Olson, M.S., CCC-SLP Interview Responses: Catlaina Vrana, PRC-Saltillo Ambassador
Imagine sitting in a house with a tin roof, in a rainstorm, and being asked to isolate the sound of a single raindrop. What a challenge that would be! This is the experience some individuals with autism have when it comes to processing language. Instead of reliably hearing separate units of speech sounds, their auditory processing system appears to experience speech and other environmental sounds very differently. They may also experience significant differences in other sensory processing systems, demonstrating significant sensitivities or discomfort with sensory input.
Differences in how a person processes speech sounds will impact their language development with both receptive and expressive language. In terms of receptive language, we may observe behavioral tendencies such as frequently not responding to their name or non-routine-based directions, or someone who seems to have a significant hearing impairment (despite testing showing hearing within normal limits). These individuals may show a strong desire to watch the same video clip over and over. They may be drawn to music and songs and show increased attention to “sing-songy” speech. Expressively, we may see someone who uses immediate and/or delayed echolalia, is able to produce long scripts of language or unintelligible strings of language with rich intonation and expressive body movements. Individuals who demonstrate these receptive and expressive speech and language characteristics are believed to be more on the Gestalt end of the continuum.
It is not uncommon for all children to demonstrate some or all of the above communicative behaviors as they learn how to become independent communicators. However, if the individual fails to acquire a substantial bank of single words, the typical path of Analytic Language Processing, they may face considerable frustrations and behavioral challenges in communication and connection.
All humans fall somewhere within the broad spectrum of Gestalt and Analytic Language Processing as they develop and learn how to functionally use language to communicate. It’s important to remember that speech and language development naturally encompasses both the micro (Analytic) and macro (Gestalt) processes of analyzing and encoding language.
Now, let's return to the question many of us ask as we work with autistic individuals who exhibit characteristics of Gestalt Language Processing and have access to Augmentative Alternative Communication (AAC): 'Where do I program the gestalts?” At the time of this writing, we simply do not have empirical evidence to help us answer this question. However, we do have a growing body of lived experiences from adult autistic AAC users which can help guide our clinical practice.
I recently met Catlaina, a young autistic woman who shares that she has significant sensory based auditory processing differences and considers herself a Gestalt Language Processor. She began using AAC when she was 15 and became a PRC-Saltillo AAC Ambassador in July 2023. Catlaina speaks to groups about her life and how she uses AAC, specifically an Accent with LAMP Words for Life, to communicate. You can learn more about Catlaina’s role as an Ambassador here: PRC-Saltillo Ambassadors.
Catlaina graciously agreed to share her life experiences by answering the following questions to help us better understand what it is like to experience the world as a Gestalt Language Processor and AAC user.
The following questions and answers were exchanged via email and Catlaina’s unedited responses are provided in quotes.
Q: Do you consider yourself a Gestalt Language Processor, either in the past or in this present time? If so, do you feel like the structure of Analytic Language Processing applies to you at all? Do you see yourself as an “either one or the other”? GLP ~or~ ALP? Or do you see yourself as functioning within the spectrum of the two extremes?
A: “Yes, I suppose I would consider myself a GLP, especially when I was younger. Because I can have a functional conversation with novel sentences, I think I’ve learned how to process language analytically, or at least translate effectively enough to where most people assume I am an analytical processor. But at a base level, for instance when I’m feeling anxious, I always have the same phrase running through my head, “but where they have really missed the boat is, we’re great guys but no one seems to notice.” It’s a quote from the musical Joseph and the Amazing Technicolor Dreamcoat. Socially, I know saying that out loud would be nonsense to others, but in my mind it makes sense contextually. People with ASD are very good at finding patterns and applying them- that is a phrase that contains a very specific emotion that my brain just finds relatable, and because of that, that phrase is communicably applicable for me (though I no longer speak in phrases.) On another note, I can’t count the times I’ve thought something was one word, when it was several. I’ve mentioned before that I thought the show “That’s So Raven” was one word (even though saying that all together is nonsense, it never occurred to six-year old me because every word kind of sounded made-up to me.) Until I was like 10 years old (embarrassingly), “4th of July” was also one word. Even in high school, when the band was going to play “Pomp and Circumstance” for graduation, I thought that was one word until I saw the title on my sheet music.”
Q: Do you recall as a young child how you experienced the world of language? What was that like?
A: “When I was really young, I didn’t get any meaning from other’s speech- it was all just sound to me for a while. I liked to parrot people a lot- especially things I heard on TV and from my older sister. I found it easier to understand repetitive phrases. I could always follow the show “Dora the Explorer” very well because of how repetitive it was. I did understand things in chunks, instead of by individual words. Putting together novel sentences has always felt a bit unnatural for me, and because I don’t think in words, I always feel like communication is more like translation.”
Q: What helped you as a child better process language in classroom situations, in public, at home? Did different environments and different communication partners impact your ability to process language differently?
A: “I was homeschooled from preschool to second grade. I think learning how to read and being read helped me learn how to segment language. With the latter, it helped me understand how flexible language could be- with words you can tell any sort of story or convey any sort of message. But I think it was learning how to read where segmentation of language finally clicked for me. Make no mistake-- it was not some magic cure for my language differences/deficits, and I found it incredibly difficult learning how to read. I do think having an older sister, who talked constantly, was helpful as well. On a separate note, the environment I am in makes a huge difference on my language processing and communication. The more overstimulated I am, the harder it becomes to understand other people. The experience is difficult to explain. My own communication also suffers. At Closing the Gap, my mom and I and the people from PRC-Saltillo were going to go out to eat at a restaurant, and the restaurant was very loud and busy. Though I had been chatting to people all day, I found it hard to string any sort of sentence together with my device. The best I could do was make the sign for “GO.” Obviously, I am capable of communicating much more than one word at a time. But not in those moments. As you can imagine, this made attending general education classes difficult.”
Q: Can you elaborate on the sensory processing differences you experience (now and in the past) and reflect on how those might have impacted your language processing. For example, did or do you experience sensitivities to sounds/noises? Do you think your sensory processing differences are separate from or integrated with how you process language?
A: “Sensory Processing Disorder is the most disabling aspect of my autism. It affects every single bit of information my brain receives from the environment I’m in, and in turn, how I respond to those informational differences. Many may not see it on camera (as I usually refrain from stimming there because it’s distracting for others), but because of my SPD, I am basically always moving. As an adult, I’ve found many ways to manage my SPD, but I struggled as a child, especially when I was a toddler. I do think that SPD has affected my language processing because of how it affects me auditorily. Out of all the senses, my brain especially sucks at processing sound. I’m extremely noise sensitive, and even places like Walmart can be overstimulating for me. I also have trouble filtering out unimportant sensory information- if someone’s bouncing their leg while we’re talking and their shoe is patting the ground- guess what I’m going to be hearing our whole conversation? The patting noise. It wouldn’t be background noise either, the patting sound would be on the same level as their talking for me.”
Q: Can you recall what it was like to learn how to read and write? I’m interested in your age when these skills started to emerge, and if you recall any specific instruction you received or tools that were used to help you learn these skills.
A: “I learned to read at a very basic level when I was around 7. I read more fluently around 8. Chapter books, especially funny ones, were very motivating for me to read. In learning how to read, I read the “BOB” books and did phonetics/sight words flash cards (which I hated), Dick and Jane and Dr. Suess (which I liked). But it was reading “Junie B. Jones” which really motivated me to gain understanding from what I was reading. Also- because I was pretty bad at learning how to read, my mom got me a Leap Pad reader. You would place a children's book in the electronic case and use the stylus to have the Leap Pad read out-loud. I was able to have it read entire sentences, but I was also able to click on individual words that would be read out-loud to me. I think this benefited me receptively as well (though the message window of a device would have been ideal haha)”
Q: When you received your AAC device at the age of 15, do you remember any changes in your ability to process language?
A: “I think having a grid-based AAC made language make more sense to me. Before high-tech, I used writing a lot of the time, and some speech. With writing and speech, I always felt like I was translating. But with AAC, I could organize my words into locations on a grid. This organization almost felt like a kind of bridge between how I think of words and communication (organized, contextual or located in its own place) and typical communication.”
Q: The field of SLP and AAC are currently in the “emerging practice” (Defining Levels of Evidence) stage with regards to our understanding of how to provide intervention supports for autistic people who present with characteristics of Gestalt Language Processing. As an AAC communicator and Gestalt Language Processor do you have advice for us SLP’s? How can we best support someone like yourself learn how to connect with and communicate with others?
A: “I’m unsure of how AAC could improve in regards to GLP. Though I use AAC most of the time now, all of my echolalia when I was a young kid was verbal- something I think is true for many with ASD (even if they don’t have functional language.) Of course, it’s always good to meet a kid where they’re at. If you can guess the purpose of the gestalt (which isn’t always easy), then you can perhaps teach a more functional way to communicate their purpose. One way you might be able to do this is by adding a picture of the reference to that word. For example, a child could say “Swiper, no swiping!” when what they really want to communicate is “no.” The image for “no” could be a picture of Swiper the fox. I’m not saying to do this with every single word in an AAC system, but it might be a good way to start meshing AAC into their existing communication.”
Q: Regarding the previous question, much like when you were learning how to read, and seeing the words on the page, I wonder how seeing and hearing single words on an AAC device, modeled for you and provided for you to explore and experience, if that would have changed the way your brain was able to process speech sounds? So, rather than using the AAC device as an expressive tool for more gestalts/phrases, but as a tool to help the brain to SEE, HEAR and EXPERIENCE single words. Do you recall when you did get your AAC device at age 15, if you began to notice things about words and speech that you were missing before. I’m really interested in if or how the AAC device changed your ability to segment incoming speech into single words, as a side benefit of using it to produce communication using those single words.
A: “Oh, I think it would have been massively beneficial. (Note- I believe it also has been beneficial receptively as an adult, but has definitely not rid me of my receptive language disability.) I think I touched on this a little bit with when I received my device at 15 (how it affected my understanding of language), but as far as hearing and understanding individual words, yes.
I think this is why some autistic people like to play portions of videos or music over and over again- I think the purpose in that is playing on our own strengths to make up for natural deficits. Autistic people tend to like repetition. When I replay a video or music clip, I'm not just listening to it- I'm studying it. (this would also apply to hearing words from a device)
Around the same time I first got my first AAC device, I was a huge fan of the show Steven Universe. There's a two second part of an episode where the character Amethyst says, "Look Steven! I'm a pachyderm." I probably listened to the two second clip hundreds of times. I was studying each frame of animation, exactly how the audio sounded. I was memorizing the way her mouth was animated to form those words. I can play that clip in my head now, in exact detail. I can even recite it verbally.
I can only imagine how access to an AAC device, where I could press a button and get auditory feedback, then get feedback from my environment in response to that communication.... Well, I think it would have been very very beneficial. If I would've been able to actively and repetitively HEAR individual words from a device, I think that may have aided my understanding of others' spoken language through recognition.”
I'd like to extend a heartfelt thank you to Catlaina for generously sharing this invaluable insight, which benefits everyone seeking a deeper understanding of autism, Gestalt Language Processing, and Augmentative Alternative Communication!
IN CONCLUSION
When it comes to our collective knowledge of providing AAC interventions for our non-speaking and/or minimally-speaking clients who exhibit primary characteristics of Gestalt Language Processing, we need to acknowledge that we don’t know what we don’t know. Every client presents us with a unique learning opportunity and we are literally building our boat of knowledge, board by board, as we sail across the sea.
Concerning the pressing question of the day, “Where do I program the gestalts?”, what if we change this question to, “What is the therapeutic rationale for programming a phrase/script/gestalt/immediate echolalia/delayed echolalia into an AAC device?”
AAC INTERVENTION TIPS:
- Honor and acknowledge ALL forms of communication. If not evident, seek to understand the meaning or function of a gestalt. This can assist in reducing frustration, increasing social and emotional connections, and providing clues on single words you can begin to model.
- Consider that challenges in speech sound discrimination appears to be the core neurological difference (likely co-occurring with behaviors demonstrating auditory sound sensitivities or dysregulation) with individuals who present as Gestalt Language Processors. The use of AAC may be just as impactful on receptive speech sound discrimination skills as it is for expressive language development. Some individuals may benefit from access to AAC to support their receptive language and speech sound development and may show less interest in using it for “functional” expressive communication, at least initially. It is OK to consider using AAC as a tool to support receptive language and speech sound discrimination development!
- Have a therapeutic rationale for programming additional phrases/scripts/gestalts into a person’s AAC device. The decision-making process should be unique to the AAC user’s needs and preferences AND, when possible, should include the AAC user. This isn’t a “one phrase fits all” approach and remember, the addition should be meaningful and motivating to the AAC user. A few examples of this include:
- Is there a sound or word that helps regulate an overstimulated sensory system? Place it where you have other sensory words or names of preferred fidget toys.
- Is there a quick phrase that grabs someone’s attention in an emergency? Place it where you store other important phrases like “my name is___”, “my mom’s phone number is ___”, “I’m allergic to nuts”.
- Is there a high value script that is only used in certain situations (e.g., trick or treat time on Halloween) or is associated with a preferred show or activity? Place it on the page with other contextually relevant or similar words.
- Is there language that can replace dysregulated and disruptive behavior (e.g., teaching the phrase “I need a break” during overwhelming situations). Place it on the page where “help” words live.
- Do not alter the original placement of core words in a robust language system. It might be tempting to program the phrase “I want to eat a cookie” on the button for the core word “eat”. In the short term, an individual might successfully use that programmed phrase to request a cookie during snack time. However, it is impossible to generalize that phrase to mean anything other than requesting a cookie!
- The development of speech, whether it’s with the mouth or an AAC device, involves the development of consistent and unique motor plans for each word and sound. This allows the communicator the opportunity to produce SNUG (Spontaneous Novel Utterance Generation) and is the pathway to motor automaticity and increased speed of utterance generation. If there is a therapeutic rationale to add gestalts to an AAC device, make plans to QUICKLY model and teach the individual units of the message.
- Follow the child’s lead, incorporate movement and sensory play during language learning activities, and HAVE FUN with language! Remember that language is a multi-sensory experience.
- As soon as possible, allow free exploration of the largest vocabulary size available! When needed, use device features like Vocabulary Builder to hide and show words during short-term, focused activities. Lack of progress and interest in the AAC device is sometimes due to not enough words.
- Pressing the same button or sequence of buttons repeatedly may have a purpose similar to watching the same movie clip over and over. When someone has trouble hearing and segmenting the individual units of speech, being able to produce and hear those words and sounds, on their own time and volition may help their auditory processing system learn how to regulate and process speech sounds better.
- Use features like highlighting spoken words in the message window, speaking words at the single word level, and include (when possible) the client when choosing a voice and adjusting the volume. Seeing and hearing single words as they are produced can facilitate literacy skills and improve speech sound segmentation. Someone with auditory processing differences may have strong preferences and/or aversions to voices and the volume of sounds.
- Frameworks like Gestalt or Analytic Language Processing are helpful in such they provide us with a general roadmap of what is possible within a broad spectrum of possibilities. They should not be used as a series of prerequisite behaviors that must be mastered in sequential order. Infants who develop language in a more analytical process (sounds, single words, combining words, etc) are offered early models of language that far exceed their motor or linguistic capabilities. Likewise, infants and children who develop language in a more gestalt process should also be offered models of language that they have not yet mastered. In other words, “don’t wait to mitigate”!
To learn more about and connect with Catlaina please visit her PRC-Saltillo Ambassador page: Catlaina Vrana.
Catlaina recently wrote a picture book called Inside Words, Outside Words. You can view and order her book here: Inside Words, Outside Words.
You can also see a conversation with Catlaina and John Halloran on the Center for AAC and Autism’s YouTube channel: Center for AAC and Autism YouTube.
To learn more about Language Acquisition through Motor Planning and the language system Catlaina uses, LAMP Words for Life, please visit the Center for AAC and Autism: Center for AAC and Autism.
Making AAC Work - glp, gestalt language processing, aac, language development.